New Tool Will Pinpoint CVD Risk in Arthritis

Action Points

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

PARIS -- Researchers from around the world are collaborating on a cardiovascular disease (CVD) risk calculator specific for rheumatoid arthritis (RA) to help clinicians more accurately assess risk among these patients.

So an international consortium of researchers from eight centers in seven countries has been constructing the ATACC-RA (A TransAtlantic Cardiovascular risk Calculator for Rheumatoid Arthritis), with the goal of bringing together data on heart disease and its risk factors, including factors associated with RA not included in other tools, explained Sherine E. Gabriel, MD, of the Mayo Clinic in Rochester, Minn., in an interview.

RA-specific factors included in the analyses included seropositivity for rheumatoid factor or anti-citrullinated protein antibodies, disease activity scores in 28 joints (DAS28), and levels of acute phase reactants.

The cohort consisted of 3,176 patients who were free of cardiovascular disease at baseline and whose mean age was 55. Three-quarters were women. Overall, during follow-up of 7.8 years, there were 314 cardiovascular events.

For each of the eight centers, the cardiovascular event rate was calculated. These were found to differ, probably because of regional variations in risk factors, according to Arts. For instance, the highest 5-year event rate was 7.7%, in South Africa, while the lowest was 2.4%, in the U.K.

On multivariate regression analyses, two models were constructed. Both models included age, sex, current smoking, hypertension, and total cholesterol-to-HDL ratio, while one also included seropositivity and the other included the DAS28 score.

All factors were significant in both models. For example, in the seropositivity model, the hazard ratios for age (per 10 years), male sex, and current smoking were 1.91, 1.70, and 1.76, respectively (P<0.001 for all). In the DAS28 model, the hazard ratios for age and total cholesterol-to-HDL ratio were 1.71 and 1.31, respectively (P<0.001 for both), and 1.66 for current smoking (P=0.001).

"Both models demonstrated good discrimination, with c-statistics of 0.76 and 0.74, and calibration, with an observed-to-predicted ratio of 1 (95% CI 0.89-1.12)," Arts reported.

The mean ATACC-RA risk score was 11.5%, which had significantly better discrimination compared with the Framingham score (c-statistic, 0.71) or the SCORE algorithm (c-statistic, 0.72, P<0.001 for both), she said.

"ATACC-RA shows promising improvement in predictive accuracy, with models developed from a large cohort of patients from all over the world. With external validation, we may have a model that will be applicable in a wide variety of patients," she said.

The risk calculator continues to be improved and modified, Gabriel told MedPage Today.

"Hopefully, this will help us do a better job at predicting risk so we can get patients into preventive programs," Gabriel said.